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Friday, August 10, 2012

Personality, Psychopathology, Life Attitudes and Neuropsychological Performance among Ritual Users of Ayahuasca: A Longitudinal Study

As far as I know, this is the first longitudinal study on the use of ayahuasca, the Amazonian entheogenic mixture that (after the purging, which is an important element of the experience), offers one of the more intense and spiritual hallucinogenic experiences recorded. It is also one of the most healing experiences, especially for addictions according to Gabor Maté.

This study shows, convincingly, that ayahuasca users are well-adjusted, lacking in psychopathology, and more spiritual (higher self-transcendence scores) than the control group.

Before presenting the new study, here is a little background on ayahuasca.

Ayahuasca (aya-spirit/dead, waska-vine/rope) or Yage (ya-hey) are native Amazonian names for the jungle vine Banisteriopsis Caapi, and the medicinal tea prepared from it. Ayahuasca is used throughout the Upper Amazon to enable access to the visionary or mythological world that provides revelation, blessing, healing, and ontological solace (Dobkin de Rios 1972, Grof 1994, Andritsky 1984).

Constituents
The Banisteriopsis caapi vine is a Malpighiaceous jungle liana found in the tropical regions of Peru, Bolivia, Panama, Brazil, the Orinoco of Venezuela and the Pacific Coast of Colombia/Ecuador. The vine is the common base ingredient of the Ayahuasca tea. B. caapi contains beta-carbolines that exhibit sedative, hypnotic, anti-depressant, monoamine oxidase inhibiting, and threshold visionary activity.

Ayahuasca is a synergystic potion. A wide variety of admixture plants is used by the indigenous tribes of the Upper Amazon. Vine-only brew is sometimes used. Most typically the vine is mixed with a tryptamine carrying plant. The foliage of Psychotria viridis (Chacruna) is the principal admixture of Ayahuasca potions employed throughout Peru and Brazil. In Columbia and Amazonian Ecuador, the plant Diplopterys cabrerana (Chaliponga) is often used instead.

These plants provide the “light” or the visionary qualities, but these tryptamine-containing plants are not orally active alone. The monoamine oxidase inhibiting action of the B. caapi vine makes it possible for the tryptamines to produce powerful visions. In turn, the admixture plants potentiate the Vine.

The combination of the Caapi vine with Chacruna or Chaliponga is sometimes known as a marriage of Power and Light. This marriage unlocks the full shamanic mareacion and its visionary mythological vistas.

This medicine has been used for millennia in order to enter the sacred supernatural world, to heal, divine, and worship.

Antiquity
The use of Ayahuasca may well be primordial, its use extending back to the earliest aboriginal inhabitants of the Upper Amazon region. Abstract liminal patterns such as zigzags, serrated lines and geometric forms found on ancient relics and traditional textiles, pottery and body art of various tribes represent the perceptual threshold between everyday and transpersonal realms of consciousness. These relics, combined with an abundance of myths describing the origin of Ayahuasca as deeply intertwined cosmologically with the creation of the universe, earth, and tribal people, indicate a long history of human use.

Ayahuasca is a revered and respected sacred medicine, considered a spiritual and physiological panacea par excellence, because its medicine can instruct in healing, visionary insight, and the art of using plants for various purposes. Sometimes it is referred to simply as La Medicina – the Medicine.

For indigenous people such as the Napo Runa of Ecuador, Ayahuasca is “the mother of all medicines” and “the mother of all plants.” Other peoples regard Ayahuasca as a Grandfather or Grandmother. Ayahuasca, “the Vine with a soul,” is perceived as a communicating being who guides, teaches, and heals. Ayahuasca also acts as a mediator and translator between the human and plant worlds, and teaches humans how to communicate with plants and use them for various purposes.

Abstract

Ayahuasca is an Amazonian psychoactive plant beverage containing the serotonergic 5-HT2A agonist N,N-dimethyltryptamine
(DMT) and monoamine oxidase-inhibiting alkaloids (harmine, harmaline
and tetrahydroharmine) that render it orally active. Ayahuasca ingestion
is a central feature in several Brazilian syncretic churches that have
expanded their activities to urban Brazil, Europe and North America.
Members of these groups typically ingest ayahuasca at least twice per
month. Prior research has shown that acute ayahuasca increases blood
flow in prefrontal and temporal brain regions and that it elicits
intense modifications in thought processes, perception and emotion.
However, regular ayahuasca use does not seem to induce the pattern of
addiction-related problems that characterize drugs of abuse. To study
the impact of repeated ayahuasca use on general psychological
well-being, mental health and cognition, here we assessed personality,
psychopathology, life attitudes and neuropsychological performance in
regular ayahuasca users (n = 127) and controls (n = 115) at baseline and
1 year later. Controls were actively participating in non-ayahuasca
religions. Users showed higher Reward Dependence and Self-Transcendence
and lower Harm Avoidance and Self-Directedness. They scored
significantly lower on all psychopathology measures, showed better
performance on the Stroop test, the Wisconsin Card Sorting Test and the
Letter-Number Sequencing task from the WAIS-III, and better scores on
the Frontal Systems Behavior Scale. Analysis of life attitudes showed
higher scores on the Spiritual Orientation Inventory, the Purpose in
Life Test and the Psychosocial Well-Being test. Despite the lower number
of participants available at follow-up, overall differences with
controls were maintained one year later. In conclusion, we found no
evidence of psychological maladjustment, mental health deterioration or
cognitive impairment in the ayahuasca-using group.

Do be sure to read the whole article, but I want to skip directly to the Discussion. The researchers looked at personality, psychopathology, neuropsychological functions, and life attitude and psychosocial well-being. In all realms, ayahuasca users scored higher than controls.

Discussion

In
this paper we present data from a field research study in which
personality, mental health, life attitudes and neuropsychological
performance were assessed in a large number of ritual ayahuasca users
and their matched controls.

1. Personality

The TCI [49]
was used to assess personality. Differences between ayahuasca users and
controls were found in several of the temperament dimensions, which are
believed to be genetically determined. Higher scores on Reward
Dependence (RD) may reflect a feature allowing the group to adapt to a
demanding environment such as the tropical rainforest. This
interpretation is supported by the significant scores on the RD
subdimensions Attachment (RD3) and Dependence (RD4), but not
Sentimentality (RD1). This profile is probably useful for life in a
small community and in a hostile ecological environment. Participants in
the Jungle sample showed a trend to higher scores on Persistence than
their urban counterparts. Higher scores on this temperament dimension
could explain the adaptation capacity shown by these people to their
environment, and the ability to persist as a group despite isolation.
Additionally, Harm Avoidance (HA) was lower in the ayahuasca-using
subjects, probably reflecting the strength in personality required to
undergo regular ayahuasca sessions for long periods of time. It is
interesting to note that there were no differences between groups in
Novelty Seeking (NS) scores nor in its subscales, including
Impulsiveness (NS2). Since high scores in NS and Impulsiveness have been
associated with drug use [50], [51],
the mere search for new experiences may not be the underlying reason of
their involvement with ayahuasca. On the contrary, members of the
ayahuasca religions report that the experiences transcend the merely
perceptual or recreational aspects of psychoactive drug effects.

The analysis
of Character dimensions showed that ayahuasca users scored significantly
higher in Self-Transcendence (ST). Since all participants (users and
controls) actively practiced some religion, and Character traits can be
influenced by personal experience and culture, this finding could be
interpreted as a direct effect of ayahuasca use. Self-Directedness (SD),
another Character dimension, is consistently lower in the ayahuasca
groups, and may also be related to ayahuasca intake. Used in a religious
context, the potent psychotropic effects of ayahuasca may strengthen
adherence to the doctrine. The lower Self-Directedness (SD) scores found
may reflect the greater relevance of the community over the individual.
At the same time, there were no differences between users and controls
in Cooperativeness (C). So despite greater Self-Transcendence and
spirituality in the ayahuasca-using group, willingness to cooperate with
others was not different from that seen in more conventional religions.
It would be very interesting to assess if subjects who have decided to
leave the group and discontinue ayahuasca use share personality traits
with the long-term users.

In a group of 15 long term urban ayahuasca users, Grob et al. [28]
found lower scores on NS and HA and no differences in RD compared to 15
matched non-users, in line with our own results. The higher RD scores
in our study, driven mainly by the Jungle sample, may reflect the
difference in environment mentioned above. Another research group has
found changes in the Temperament dimensions of the TCI after 6 months of
regular ayahuasca use in a religious setting in subjects who were
initially naïve to ayahuasca. However, these same subjects did not show
changes in the Character dimensions [52].
Based on these findings, a less conservative explanation for the
differences observed in Temperament traits in the present study would be
that they are a consequence and not the cause of ritual ayahuasca use.
This would mean that ayahuasca may induce changes in personality traits
traditionally considered inherited. A recent study in which high doses
of psilocybin were administered in a supportive setting showed positive
long term changes in Openness to Experiences [53].
This temperament trait is considered to be the most substantially
heritable trait in the Big Five personality model, and relatively stable
through adulthood [54].

2. Psychopathology

The analysis
of psychopathology indicators showed the important finding that
ayahuasca users scored significantly lower on all nine dimensions of the
SCL-90-R. The two immediate explanations for this finding are that
either ayahuasca has a low potential to induce psychopathology, or that
samples of long-term users suffer from a self-selection bias by which
only those who do not experience adverse psychological effects continue
ayahuasca use. Regarding the second explanation it is worth mentioning
that at follow-up lower scores were still seen on most dimensions,
despite the loss in sample size. Similar findings have been reported in
the literature. In a study where a group of 32 long term US ayahuasca
users were assessed with the same instrument, scores were significantly
lower than normative data for 7 of the 9 dimensions [31]. Halpern et al. [55]
did not find evidence either of psychopathology in a group of peyote (a
mescaline-containing cactus) users when compared to controls. Grob et
al. [28]
did not find evidence of psychopathology in their ayahuasca-taking
sample using the CIDI (Composite International Diagnostic Interview),
despite the fact that in the retrospective assessment most subjects met
criteria for psychiatric disorders prior to their religious use of
ayahuasca. Another study with teenage members of an ayahuasca church did
not find differences with the control group, but rather showed a
tendency to an improvement in some measures of psychopathology [30]. Barbosa et al. [52], [56]
also failed to find psychophatological symptoms both in the short-term
after a first ritual ayahuasca experience, and at follow up 6 months
after continued use. Some participants even showed a decrease in minor
psychopathological symptoms.

In summary, though there are case reports describing psychiatric complications following ayahuasca intake [24], [25],
it appears that current long-term users do not show higher
psychopathology. One study reported that some experienced users even
show reduced scores of panic and hopelessness while under the effects of
the tea [57].
Future research should assess not only long-term users but also
ex-users to evaluate whether adverse psychological effects play any role
in the decision to discontinue use. The apparent contradiction between
reports of psychiatric crisis after acute ayahuasca and the absence of
psychopathology in many chronic users should be studied in more detail.

One last
consideration is the potential bias introduced by the self-assessment
nature of the SCL-90-R. Subjects may have been inclined to give socially
acceptable responses. However, scores on the PST subscale were always
higher than 3–4. According to the interpretation norms for the SCL-90-R [58],
low scores on this subscale would be indicative of a social
desirability bias. Further support for the validity of our present
findings is derived from results in the neuropsychological assessment
(see below). Psychiatric disorders are commonly accompanied by
neuropsychological deficits [59], [60], but these were not observed in the ayahuasca-using subjects in the present study.

3. Neuropsychological Functions

Based on the
administered tests and the Frontal Systems Behaviour Scales, we found no
evidence of neuropsychological impairment in the ayahuasca-using group.
Furthermore, in general terms they scored better than their respective
comparison groups and these differences were maintained one year later.

These results do not fit the hypothesis of potential frontal impairment secondary to 5-HT2A receptor activation, and are more in line with prior observations in users of psychedelics. Grob et al. [28]
found no working memory deficits in their sample of ayahuasca users,
but rather an improvement in one memory subset. Da Silveira et al. [29]
did not find deficits in the stroop and other neuropsychological tests
in their group of adolescent ritual ayahuasca users. These users did not
score differently than their control group in most variables. They did
fare worse on some memory subtests, but results were within the normalcy
range. Halpern et al. [55]
did not find neuropsychological impairment in a group of long term
peyote users from the Native American Church. Tests included the Stroop
test, the Wisconsin Card Sorting Test and working memory tests. Although
more research is needed before definite conclusions can be drawn
regarding this drug class, based on the available evidence chronic use
of psychedelics does not seem to cause cognitive impairment.

The lack of
cognitive impairment in our ayahuasca users can not be attributed to a
lack of sensitivity of the neuropsychological tests administered, as
they were sensitive enough to differentiate between users and non users.
The Stroop task and the Wisconsin Card Sorting Test tap various
cognitive functions such as selective attention, behavioral inhibition,
working memory and goal-directed behavior, and are sensitive to PFC
damage [61].
Also, these same tests have been found to detect neuropsychological
impairment in various groups of drug abusers. For example, the Wisconsin
Card Sorting Test has proven sensitive to detect flexibility
impairments in non-addicted cocaine polydrug users (between 1–4 gr. of
cocaine per month). This population showed more Perseverative Errors,
fewer Categories Completed and worse Conceptual Level Responses than
matched controls [62]. Also, the Stroop test was sensitive to detect executive dysfunctions in individuals using alcohol [63], cocaine [64] and amphetamines [65]. The same applies to the Letter-Number Sequencing task [66].
However, the detection of differences between users and non-users is
known to be influenced by the length of the abstinence period, the
severity and duration of the addiction, the use of multiple drugs and
the presence of associated psychopathology [67].
In any case, better performance in the drug-using group is rarely found
in the literature other than for the psychedelics. Animal research has
shown that 5-HT2A receptor activation plays a role in normal neuropsychological and memory functioning [68]–[71].
Another explanation for the present results has to do with motivation.
There is evidence that motivation may in fact improve performance of
drug users in neuropsychological tasks [72].
While the recruited ayahuasca users may have been motivated to
demonstrate the safety of ayahuasca to researchers, the controls did not
obtain any specific benefit from their participation in the study.

Concerning the
capacity of the Frontal Systems Behaviour Scales, a self-report
questionnaire, to detect impairment, it is worth noting that it has
revealed deficits in non-addicted [73] and addicted polydrug users [74], [75].
The lower scores found for our ayahuasca subjects on this measure of
prefrontal deficits is consistent with their better neuropsychological
performance. This result was found for both samples in the first
assessment and in the second.

4. Life Attitude and Psychosocial Well-being

All SOI scores
were consistently higher in both samples and along time for the
ayahuasca users, in consonance with scores on the Self-Transcendence
subscale of the TCI. Although a recent study showed no significant
differences in spiritually after an ayahuasca session, the magnitude of
the observed change was positively correlated with the intensity of the
peak of the experience [76]. The qualitative data recorded revealed common spiritual themes among participants [76].
In our first assessment, ayahuasca users showed higher scores on
Purpose in Life, although this finding was not replicated one year
later. This difference in Purpose of Life may be understood as a
consequence of the religious use of ayahuasca, and is compatible with
adherence to a religious belief [77].
In line with the above results, ayahuasca users scored higher on
subjective psychological well-being. In a previous report where these
same participants were assessed on frequency and degree of illicit drug
use, ayahuasca users scored lower on the different dimensions of the
Addition Severity Index (ASI; [23]).
Taken together, the data point at better general mental health and
bio-psycho-social adaptation in the ayahuasca-using group compared to
the control subjects.

For lovers of details, this one is particularly relevant - the control group was chosen due to their spiritual practices, so that the groups would be evenly matched in terms of spirituality. Despite this, the ayahuasca group score higher on the Spiritual Orientation Inventory.

The Spiritual Orientation Inventory (SOI)

In the first
assessment, ayahuasca users showed significantly higher scores on all 9
components of the SOI, as revealed by a main Group effect on
Transcendent Dimension [F(1,216) = 153.54; p<0.001], Meaning and
Purpose in Life [F(1,216) = 78.44; p<0.001], Mission in Life
[F(1,216) = 76.62; p<0.001], Sacredness of Life [F(1,216) = 30.14;
p<0.001], Material Values [F(1,216) = 66.78; p<0.001], Altruism
[F(1,216) = 19.32; p<0.001], Idealism [F(1,216) = 25.59; p<0.001],
Awareness of the Tragic [F(1,216) = 48.64; p<0.001], and Fruits of
Spirituality [F(1,216) = 91.03; p<0.001]. A significant Group by Sample
interaction was found for the latter dimension [F(1,216) = 4.45; p =
0.036], with differences between users and controls being larger in the
Urban sample than in the Jungle sample.